Healthcare Provider Details

I. General information

NPI: 1669382610
Provider Name (Legal Business Name): NOE ALBERTO AYALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20941 GRESHAM ST APT B
CANOGA PARK CA
91304-1865
US

IV. Provider business mailing address

20941 GRESHAM ST APT B
CANOGA PARK CA
91304-1865
US

V. Phone/Fax

Practice location:
  • Phone: 818-675-4930
  • Fax:
Mailing address:
  • Phone: 818-675-4930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA105301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: